Enhanced recoveryprogrammeInformation for patients havingcolorectal surgery

Who is this leaflet for?This leaflet is aimed at patients who are having colorectal surgery. It explainsthe enhanced recovery programme, and how you can play an active part in yourrecovery following your operation. If there is anything you are not sure about,please ask. It is important that you understand so that you, and possibly yourfamily or friends, can take an active role in your recovery.

What is the enhanced recovery programme?This is a programme of care that has been developed to allow you to recovermuch more quickly following your operation. It includes:

improved nutrition (before and after your operation)•

physiotherapy•

effective pain control.•

What are the benefits of the programme?The programme aims to improve your recovery rate and reduce your stay in hospital.

Eating and drinkingAt the pre-assessment clinic the week before your operation, you will be askedto taste some nourishing drinks called fressubin and fressubin juice. You willthen be given four drinks of your choice to take home. Drink these as follows:

two days before your operation - have three of the drinks•

on admission day - have one of the drinks before you come to hospital.•

More nourishing drinks will be available while you are in hospital. You will begiven two more on the ward before your operation. Afterwards, it is importantto drink three nourishing drinks each day as your body will need morenourishment to:

help heal your wounds•

reduce the risk of infection •

help your recovery generally. •

You also need to have ordinary drinks which will be provided.1

A few hours after your operation, you will be able to start drinking and, if youwish, eating. It is important that you eat and drink early after your operationand we will encourage you to have normal food as well as nourishing drinks.

Preparing for theatreOn the day before your operation, you may be asked to have some medicine tohelp clear your bowel. This will give you loose stools and it is important thatyou drink plenty of fluid to replace what is lost. Otherwise, you may feel dizzy,sick or have a headache. You may also have an enema two hours before youroperation to clear the lower end of your bowel.

You will be given a small injection of Fragmin at 10pm. This helps reduce therisk of thrombosis (a blood clot) occurring in your legs by thinning your blood.This will be given to you each day while you are in hospital and maybecontinued for a period of up to 28 days upon discharge.

Staying out of bed and walkingAfter you wake up from your operation, it is important that you start deepbreathing exercises:

Sit upright, staff will assist you to do this.1

Support your abdomen with a towel and your arms, bring your 2knees up slightly and lower your shoulders.

Breathe in through your nose and out through your mouth slowly. 3

Do this three times and then ‘huff’ with your mouth as if trying to 4clean spectacles.

Repeat these steps twice. 5

Repeat this exercise every hour. This should reduce the risk of a chest infection.You should also point your feet up and down and circle your ankles to reducethe risk of clots in your legs.

The staff will help you out of bed about six hours after your operation, and youwill spend two hours out of bed.

On the following days, you will spend at least eight hours out of bed, and wewill encourage you to walk about 60 metres four to six times a day.

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By being out of bed in a more upright position and by walking regularly, yourlung function is improved and there is less chance of developing a chestinfection as more oxygen is carried around your body to the tissues.

Try to wear your day clothes after your operation as this can help you feelpositive about your recovery.

Pain controlIt is important that your pain is controlled so that you can walk about, breathedeeply, eat and drink, feel relaxed and sleep well. You may have an epiduralinjection in your back, which will allow you to receive a continuous supply ofpain relieving medicine. The doctors will also prescribe other types of painrelieving medicines, which work in different ways. If you have these regularly(three or four times per day) they should help you feel more comfortable. If youare uncomfortable, please tell the staff immediately and they will help you. Theepidural will be removed two days after your operation but you will continuewith the other pain relieving medicines.

SicknessFollowing your operation, you may feel sick or be sick. This is usually caused bythe anaesthetic agents or drugs we use. You will be given medication duringsurgery to reduce this, but if you feel sick following your operation please tellthe staff, who can provide other medications. It is important to relieve sicknessto allow you to feel better so that you can eat and drink normally, which willhelp your recovery.

Tubes and dripsDuring your operation, a tube will be put in your bladder so that we can checkthat your kidneys are working well and producing urine. This will be removed assoon as possible, usually on the morning after your operation.

You will also have a fluid drip put in your arm to make sure you get enoughfluid. This should be removed the day after your operation. You may also begiven extra oxygen to breathe after your operation until you are up and about.

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MonitoringDuring your treatment, we will monitor many different things including:

fluid in•

food eaten•

fluid out•

when your bowel first starts working•

pain assessment•

number of walks•

time out of bed.•

Please remember to tell us about everything that you eat and drink and what you pass. We will encourage you to write some of this information on the charts yourself.

What happens when I leave hospital?Complications do not happen very often but it is important that you know whatto look out for. During the first two weeks after your operation, if you areworried about any of the following, please phone the telephone numbers onthis leaflet. If you cannot contact the people listed, then ring your GP.

Your woundIt is not unusual for your wound to be slightly red and uncomfortable duringthe first one to two weeks. Please let us know if your wound is:

becoming inflamed, painful or swollen•

starting to discharge fluid.•

Your bowelsYour bowel habits may change after part of your bowel is removed. Your stoolsmay become loose or you may become constipated. Make sure you eat regularmeals three or more times a day and take regular walks during the first twoweeks after your operation.

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If you are passing loose stools more than three times a day, for more than four days, take medication such as loperamide, lomotil or codeine phosphate.Alternatively, if you are constipated for more than three to four days, take a laxative.

Passing urineSometimes after bowel surgery, you may experience a feeling that your bladder is not emptying fully. This usually resolves with time. If it does not, or if you have excessive stinging when passing urine, please ring us as you mayhave an infection.

Abdominal painWhen you have had a part of your bowel removed, you may suffer griping painsfor a week afterwards. This pain usually lasts for a few minutes, but will goaway completely in between spasms.

Severe pain that lasts for several hours may mean that fluid is leaking from thearea where your bowel has been joined together. This can be a seriouscomplication which, fortunately, happens only rarely. Should this occur, it maybe accompanied by a fever. It is also possible for leakage to occur which makesyou feel generally unwell and causes fever but is without any pain.

If you have severe pain lasting more than 1-2 hours or have a fever and feelgenerally unwell, contact us on the telephone numbers provided.

What should I eat and drink?A healthy, varied diet is recommended. Make sure you eat regular meals atleast three times a day. You may find some foods cause looseness of yourbowels. If this is the case, avoid these foods for the first few weeks followingyour operation.

If you are finding it difficult to eat, have three to four nourishing (protein)drinks per day to supplement your food and make sure you get enough proteinand calories. These can include any of the nourishing drinks you tried beforeyour operation, or over-the-counter drinks such as Build-up or Complan. If youhave diarrhoea, it is important to replace the fluid loss by drinking extra liquid.

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When can I resume normal activities?ExerciseActivity is encouraged from day one following your operation. Take regularexercise several times a day. Gradually increase your exercise during the fourweeks following your operation until you are back to your normal level of activity.

Following your operation:

don’t lift anything heavy for six weeks•

don’t jog or swim for two weeks, and then start gradually.•

Use common sense to guide your exercise and rehabilitation. If your wound isuncomfortable, go easy with your exercise. Once your wound is pain free, youcan do most activities.

WorkYou may return to work within two to four weeks following your operation.However, if your work involves heavy, manual labour, do not return to work forsix weeks.

Hobbies/activitiesIn general, take up your hobbies and activities as soon as possible after youroperation, as this will benefit your convalescence. However, don’t do anythingthat causes significant pain or involves heavy lifting for 6 weeks following youroperation.

DrivingDo not drive until you are confident that you can drive safely. It is best to checkwith your insurance company before you start driving again.

Contact usGastrointestinal nurse specialistsMonday – Friday 8am – 6pm07917243118

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If you would like this leaflet in large print, braille, audio version or inanother language, please contact the Patient Advice and LiaisonService (PALS) on 01872 2532793

RCHT 928© RCHT Design & Publications 2007

Revised 05/2017 V2 Review due 05/2020